A nurse is collecting data from an adolescent client 24 hours after admission. Which of the following findings should be reported immediately?

Choice A rationale

Erythema infectiosum does not typically present first on the arms. This viral infection, caused by parvovirus B19, characteristically begins with a bright red rash on the face. It can later spread to the extremities, including arms, but this is a secondary feature.

Choice B rationale

The legs are not the initial site for the rash. Fifth disease progresses from the face to the trunk and limbs. The legs are involved in the later stages, particularly during the rash's spreading phase.

Choice C rationale

The rash in erythema infectiosum first appears on the face, often described as a "slapped cheek" appearance. This hallmark feature is due to parvovirus B19's predilection for vascular endothelial cells in facial capillaries, leading to the characteristic erythema.

Choice D rationale

The abdomen is not the primary location for the rash. While the rash may extend to the trunk and abdomen as it progresses, the initial site is the face. Secondary spread occurs via hematogenous dissemination.

Choice A rationale

Elevated total protein in cerebrospinal fluid suggests increased inflammation and permeability of the blood-brain barrier due to bacterial meningitis. Proteins, primarily immunoglobulins, leak into CSF during infection. Normal CSF protein levels range from 15-45 mg/dL, and significant elevation indicates pathological changes consistent with bacterial involvement.

Choice B rationale

Decreased white blood cells contradict bacterial meningitis, as infection prompts immune response elevation. Elevated WBCs, typically neutrophils, indicate the body’s defense against bacterial pathogens. Normal CSF WBC range is 0-5 cells/µL, and deviations confirm meningitis diagnosis.

Choice C rationale

Decreased pressure in CSF indicates other neurological conditions rather than bacterial meningitis. Bacterial infections often increase intracranial pressure due to inflammation and fluid buildup, aligning with typical diagnostic findings.

Choice D rationale

Elevated glucose in CSF contradicts bacterial meningitis diagnosis. Bacteria consume glucose, leading to low CSF glucose levels relative to blood glucose. Normal CSF glucose levels range from 40-70 mg/dL, and reduction suggests bacterial growth and metabolic activity. .